In this chapter the author attempts to pull together some thoughts on the relevance of psychoanalysis in contemporary inpatient care, by exploring the challenges posed to clinical psychologists when working with highly psychologically damaged individuals and as part of a multidisciplinary team (MDT) on the ward.

The author argues that the depth and sophistication of psychoanalytic thinking can contribute significantly toward or even make possible, treatment of hospitalized individuals whose disturbance stems from complex and traumatic experiences and who have often been untouched by other psychological models of interventions. The paper demonstrates how psychoanalytic theories can inform the psychologist’s formulation of patients’ presentations and pathologies, and how this, in turn, can help shape their MDT treatment plan.

For this, the presentation and treatment of two patients diagnosed with a personality disorder are explored, using the concept of identification with the aggressor developed by S. Ferenczi (1949) and A. Freud (1936). The psychoanalytical theories around identification will help bypass differences in their presentations, one as a victim and another as a perpetrator, and see through a similar core feature of their pathology. The author explains how this understanding influenced their treatment plan at different levels on the ward. Firstly, by incorporating psychoanalytic techniques in one to one sessions and secondly by helping the team understand the unconscious communications of their behavior and respond to these in helpful ways.